Evidence Tools
Bullying

Promising:

• Clinical Tool for Youth Risk Screening and Health Education (MI; 2020)
  
• Education, Universal Screening, and Services and Supports for Students (NC; 2021)
  

KEY FINDINGS

• Targeted interventions (i.e., those tailored to youth at risk for bullying) alone do not appear to be effective in reducing bullying.
• Universal strategies such as those implemented in classrooms (e.g., classroom instruction or class rules) and/or schools (e.g., school rules or teacher/staff training) appear to be somewhat effective.
• Combining classroom and school level interventions appears to be more effective than implementing either alone.
• Multi-tiered approaches including both targeted and universal strategies may offer added benefits.
• Peer-led programs such as peer mediation yield mixed results.
• Zero-tolerance policies,

IMPLICATIONS

• Future efforts should focus on improving the adoption, implementation fidelity, and sustainability of evidence-based programs.
• Research is needed to assess the effectiveness of interventions targeting vulnerable subgroups of youth, as the likelihood of being bullied varies by race/ethnicity, gender, and sexual orientation.
• Evaluations of interventions addressing cyberbullying in the US are needed to understand how to address this issue confronting our nation’s youth.

EVIDENCE ANALYSIS REPORTS

• Bullying: Evidence Review Brief. A three-page summary of report methodologies, results, key findings, and implications.
• Bullying: Evidence Review Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address this NPM to serve as the foundation for accountability across all states and jurisdictions. The evidence review uses a structured approach to evaluate the available empirical evidence and to draw conclusions for MCH programs based on the best available evidence. Read about the evidence analysis report methodology | You can also access the full set of Evidence Analysis Reports.

 

Watch a short video discussing state-of-the-art, evidence-based/informed strategies that can be used or adapted as ESMs. Experts in the field discuss approaches, the science, and specific ways that Title V agencies can implement and measure these approaches. Presented by Sue Limber, Clemson University.

 

• MCH Needs Assessment Toolkit: MCHneeds.net
• Root-Cause Analysis (RCA): Fishbone Diagram Tool
• Results-Based Accountability (RBA) Summary
• Population Turn-the-Curve Strategy Tool
• Performance ESM Quadrant Measurement Tool

Many of the strategies with the strongest evidence supporting them are those that are more clinical or those based in enabling services rather than those that can be easily implemented by Title V agencies. As we look to “move down the MCH Pyramid” with less emphasis on direct services (disease management) to an increased focus on public health services and systems (primary and secondary prevention and population health management), we are often challenged in identifying evidence-based/informed practices to meet the new focus of the transformed MCH Block Grant.¹ 

Where possible, we try to align evidence-based strategies (“what works”) to activities that can be adopted by Title V agencies (“what we can do”). However, there is often the need for adaptation and innovation.² Sometimes it’s difficult to identify the role a Title V agency could take in implementing and/or adopting such evidence-based/informed strategies.

When deciding how best to implement a strategy that seems outside the typical role of Title V, it may be helpful to consider activities that support the strategy while aligning with activities that Title V is charged with,³ such as:

• Assessing ongoing community needs: Title V can use data collected by programs, evaluations, or more formal needs assessment findings to see if the strategy could address identified service gaps or build equity in access and positive health outcomes.
• Informing and educating the public: Title V can provide educational/outreach materials to families/consumers to advance the strategy through training and peer support.
• Engaging community partners and families: Title V can serve as the convener for those groups/organizations that can implement the strategy.
• Integrating systems of public health. Title V can help ensure access, sharing of resources, and coordination of services to assure maximum impact of the strategy (coordinating the public health approach, health care, and related community services).
• Educating the MCH workforce (building capacity): Title V can partner with groups actually conducting this strategy in order to train MCH and healthcare professionals in strategy implementation.
• Developing public health policies and plans: Title V can support adoption of the strategy at a state level.
• Ensuring quality improvement and promoting applied research: Title V can collect data and evaluate programs in the state/jurisdiction that are implementing this strategy to build the evidence base and promote rapid innovation.

Not all strategies are effective for all population groups, and the evidence is often lacking in terms of using specific strategies to advance health equity.

Once the evidence has been considered for what works generally, it is important to understand if a specific strategy will work for targeted populations, especially those most affected by health disparities. Implementation science helps to translate the science into programs and policies that impact health outcomes in light of multiple social determinants. In finding strategies to meet needs, we have the ability to adopt and/or adapt what works.

ADOPT Strategies to Meet Needs

In choosing to adopt an existing strategy based on existing science and practice, we should consider:²

Is the study sample or population similar to our target audience?

• ​Geography
• Demographic characteristics
• Culture, values, and preference
• Health status
• Other characteristics of interest 

Do we have the resources needed to implement?

• ​Workforce capacity
• Money
• Time
• Leadership 

Does our organization and the broader environment support the strategy? ​

• Political support
• Financial and legal support
• Champions for intervention
• Community norms and partnerships
• Title V priority and jurisdiction
• Favorable environment for change​​

Adapt Strategies to Meet Needs

Not all strategies are effective for all populations. To adapt strategies to meet needs, we should consider:⁵

What about the existing strategy works? If we understand the key ingredients of a strategy, we can replicate and/or adapt the effective components. Looking at a strategy through a health behavior theory identifies key ingredients. Here are several to consider:

• Intrapersonal. Theory of Planned Behavior, Health Belief Model, Stages of Change Model.
• Interpersonal. Social Cognitive Theory, Social Norms Theory.
• Community. Diffusion of Innovation, Ecological Models.

How does it work? Being specific about the underlying mechanisms can help us increase the impact. Developing a logic model with program actions, targets, outcomes, and moderators allows you track the process from action to outcome.

For whom does it work, and for whom does it not work? When we know who is and is not responding, we can make targeted adaptations to improve outcomes. Think about the program life cycle:

• Precision. Understand what a strategy entails so you can go beyond “does it work,” to “what about it works” and “for whom does it work.”
• Fast-cycle iteration. Incorporate new ideas as you go – what is working and what is not working.
• Shared learning. Create a mechanism to share learning about success and failures.
• Co-creation. Bring together multiple parties to create a mutually valued outcome.

In what contexts does it work? By evaluating the context in which a strategy is implemented, we can adapt it for other settings. The best way to ensure that a strategy is effective is to conduct a robust evaluation. The MCH Navigator’s Evaluation Spotlight provides trainings and resources related to the steps and standards for effective program evaluation.

• Find field-based resources focused on reducing bullying relevant to Title V programs in the MCH Digital Library.
• Search the Established Evidence database for peer-reviewed research articles related to strategies for reducing bullying.
• Request Technical Assistance from the MCH Evidence Center
• MCH Evidence Center Frameworks and Toolkits:
  • MCH Evidence Framework
  • Blueprint for Change for CYSHCN Toolkit
  • Maternal Health Toolkit
  • Life Course and Social Determinants Resource Brief

• Children's Safety Network: An MCHB-funded technical assistance resource center, this project supports NPM 9 topic areas.
• Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.
• StopBullying.gov: A federal repository of trainings, state laws and policies, information for schools, and guidelines for children and adolescents on bullying, cyberbullying, and prevention strategies.
• Implementation Toolkit for National Performance Measure 9 (AMCHP). This toolkit contains examples of state strategies being used to address NPM 9 in Title V programs.
• Rural Suicide Prevention Toolkit (Rural Health Information Hub). The toolkit compiles evidence-based and promising models and resources to support organizations implementing suicide prevention programs in rural communities.